SPPC Blog

Reflections from Dr Derek Doyle

As I sat at
the bedside of my much-loved wife dying in St Columba's Hospice a few months ago my mind inevitably went back 40 or more years
to things that were said to me in those 'early days'. The people who uttered them
would never have thought of them as so important as to be repeated years and
years later but history has shown they are. Let me share them with you now but
not in any special order.

I am
indebted to many of the pioneers of Palliative Care here in Edinburgh, many UK
cities, most European countries, North
America, Hong Kong, Japan, New Zealand and Australia.

Read, then stop and think!

"Palliative care is just good, compassionate care - very much needed but not a new discovery."

"Hospice /palliative care is no more / no less that just good compassionate
caring."

"Doctors are getting better at keeping people alive but they
seem to forget that all life must have quality rather than quantity."

"From their student days doctors have been trained to see
death as a mark of failure. Who wants to work with failure?"

"Doctors seem to have been taught more about opioid dangers than their genuine
benefits."

"Good doctors have been giving excellent palliative care for
years but did not give it a fancy name."

"Contrary to what so many hospital doctors think, GPs are not
idiots. They should try it for a month!"

"How do you prevent this palliative care ward becoming like
all the general wards in this hospital?"

"There would be fewer
calls for euthanasia if all doctors were up-to-date on pain management which is
getting better year on year."

"Are GPs really so busy, even in an occasional evening, that they cannot visit a patient in the local hospice?"

"Listen to the nurses - they often know more about a patient
than doctors think."

"Don't snigger at a
patient wanting someone to help them pray or read a passage from the Bible for
them - most people look for spiritual (though
not necessarily denominational)
meaning as death approaches."

"Your new specialty - Palliative Medicine - will only survive and justify its existence
if it gives high priority to research."

"Remember to reassure patients and relatives that research is not experiments on them."

"Remember that many ( possibly most) dying people secretly wonder if they are dying because of something they have
done or failed to do."

"Take every possible opportunity to teach students - medical, nursing,
divinity....... Time spent on tutorials
is NEVER wasted."

"Remember that Mr and Mrs Public think medical research is
experimenting on animals and dying
humans. The very word can upset some people."

"Remember that many relatives of a dying person wonder if they
are candidates for the same condition."

"Old-fashioned as it may sound, most patients like doctors
to shake their hand on ward rounds or to
hold a hand of a doctor or nurse speaking to them."

"No matter how busy a palliative medicine doctor is, 10-20
minutes with the closest relatives of a
new patient is NEVER wasted time."

"Always explain why a test is being done and how it might help
(good practice anyway)."

"Ask first, and if a patient wants to know why medication is
being changed, explain."

"Remember that most people are unsure what
'lesions', 'tumours', 'malignancies', 'cancers', and 'sarcomas' are!"

"Try to explain as much as possible to terminally ill people
but do not bewilder them more than ever
- they are often very muddled anyway."

"Do hospice doctors really know what life is like in a frantically busy, under-staffed, under-funded ward in a general
hospital?"

"I expected to see the nursing staff fraught, nervous or
red-eyed from crying. What's the secret?"

"Two years ago I came on this committee looking at your
application for specialist status of Palliative Medicine. I was opposed to it
and ready to walk out. Now I see it as one of the greatest developments in Medical Care in a generation."

This blog is by Dr Derek Doyle OBE, Honorary President of the Scottish Partnership for Palliative Care. Recognised worldwide for the contributions he has made to palliative care, he was the first Medical Director of St Columba’s Hospice, the first Chairman of the Association of Palliative Medicine, the founding Editor in Chief of Palliative Medicine and Senior Editor of the first three editions of the Oxford Textbook of Palliative Medicine.